Organic mental disorders are those caused by physical brain damage. Examples of causes include toxins, heavy metals like lead or mercury, degenerative brain diseases like Alzheimer's disease and Huntington's chorea, strokes, trauma, tumors, cerebrovascular disease, genetic or congenital brain deformities, drugs and many other diseases. Doctors frequently refer to organic mental disorders in general as organic brain syndrome (OBS). For adults, the SSA frequently uses tests of neurological and mental functioning (neuropsychological testing) like the Halstead-Reitan and Luria-Nebraska tests. These tests require psychologists or psychiatrists experienced in their use and interpretation.
It is important that family members and others in frequent contact with the claimant make accurate observations about how the claimant's daily activities are abnormal and that they give this information to the SSA. For example, it is an important observation that an adult claimant or older child gets lost traveling alone, since that can indicate disorientation and memory impairment. Family members may note a change in the claimant's mood, such as depression and withdrawal or unstable emotions like sudden crying. Such observations can help examining psychiatrists or psychologists and the SSA reach a more accurate evaluation of the severity of the organic mental disorder.
The manifestations of organic mental disorders depend on the cause, location and severity of the brain abnormalities, including the age of the patient. It is important to understand that a fall in IQ associated with organic brain damage, such as that caused by brain trauma from an automobile wreck, produces much more serious limitations than in a person who is born with the same low IQ. In other words, a person who is born with an IQ of 70 will be much more capable than a person with an IQ of 100 whose IQ falls to 70. The reason for this is that a fall in IQ in a previously normal person diminishes other capacities in addition to intellect.
For your condition to be severe enough to meet this listing, you must have psychological or behavioral abnormalities associated with a dysfunction of the brain. History and physical examination or laboratory tests must demonstrate the presence of a specific organic factor causing the abnormal mental state and the loss of previously acquired functional abilities.
The required level of severity is met when both ® and ® are satisfied, or when the requirements in © are satisfied. Part ® provides abnormalities that may be present in organic mental disorders. Parts ® and © discuss the functional severity of the disorder—that is, how it limits the claimant.
® Demonstration of a loss of specific thinking abilities or emotional changes and the medically documented persistence of at least one of the following:
2. Memory impairment, either short-term (involving an inability to learn new information), intermediate or long-term (involving an inability to remember information that was known sometime in the past).
3. Perceptual or thinking disturbances (for example, hallucinations, delusions).
4. Change in personality.
5. Disturbance in mood.
6. Emotional lability—such as explosive temper outbursts or sudden crying and impairment of your impulse control.
7. Loss of measured intellectual ability of at least 15 IQ points from premorbid levels or an overall impairment index that clearly falls within the severely impaired range on neuropsychological testing—such as the Luria-Nebraska or Halstead-Reitan.
® Demonstration of a loss of specific thinking abilities or emotional changes resulting in at least two of the following:
1. Marked restriction of activities of daily living.
2. Marked difficulties in maintaining social functioning.
3. Marked difficulties in maintaining concentration, persistence or pace; or
4. Repeated episodes of decompensation, each of extended duration.
© Medically documented history of a chronic organic mental disorder lasting at least two years that has caused more than a minimal limitation of ability to do basic work activities, with symptoms or signs currently decreased by medication or psychosocial support and one of the following:
1. Repeated episodes of decompensation, each of extended duration; or
2. A residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate; or
3. A current history of inability to function outside a highly supportive living arrangement for one or more years with signs that you'll continue to need such an arrangement.
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